Robotic Surgery tomorrow morning, emergency question!

Replicant · Moderator Joined: 01 Nov 2006 Posts: 860

Thanks for the kind words. I'm not sure why my doctor didn't remove any lymph nodes. There may have been some difficulty that didn't make it into his notes. I was in surgery a long time compared to men who have experienced robotic surgeons.
Mine was very experienced in open, but I was his first robotic.
I have noticed that I have one incision quite a bit larger than the others, too. It's my only noticeable scar, and it's about 2 inches long.
So I always suggest that men make sure their surgeon is very experienced, no matter whether it's open or robot-assisted.

I am happy that he spared the neurovascular bundles, though, so ED is manageable and I was also able to regain continence quickly.

I would summarize my stance towards salvage radiation as follows: IF the man and his doctors decide radiation is in his best interest, move quickly. And don't wait to investigate salvage, either. I think that in my case, I came close to waiting too long. While my PSA was rising, my uro had me come back in 4 months. 4, not 3. Why? During that time, my PSA tripled! And still, he didn't seem overly worried. The holidays were upon us, and it wasn't easy to get appointments in a timely fashion. The only reason I got going quickly--while my PSA was below 1.0, was that I had been doing my homework and knew that the clock was ticking.

I think that some urologists are a little too nonchalant about rising PSA after surgery. They need to read up more on the current research, and be quicker to refer their patients to radiation oncologists, since pre-radiation PSA is clearly a significant factor in success.

But I acknowledge that salvage is not for everyone whose PSA rises It's a second chance at a cure---the operative words being "chance" and "cure". It's only recently that salvage radiation has been show to apparently have a survival benefit.

Hope your recovery is still going well.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Travelingman · Posted: Wed Nov 04, 2009 5:44 am Post subject: Re: thanks

[quote="Replicant"]Thanks for the kind words. I'm not sure why my doctor didn't remove any lymph nodes. There may have been some difficulty that didn't make it into his notes. I was in surgery a long time compared to men who have experienced robotic surgeons.
Mine was very experienced in open, but I was his first robotic.
I have noticed that I have one incision quite a bit larger than the others, too. It's my only noticeable scar, and it's about 2 inches long.
So I always suggest that men make sure their surgeon is very experienced, no matter whether it's open or robot-assisted.

I am happy that he spared the neurovascular bundles, though, so ED is manageable and I was also able to regain continence quickly.

I would summarize my stance towards salvage radiation as follows: IF the man and his doctors decide radiation is in his best interest, move quickly. And don't wait to investigate salvage, either. I think that in my case, I came close to waiting too long. While my PSA was rising, my uro had me come back in 4 months. 4, not 3. Why? During that time, my PSA tripled! And still, he didn't seem overly worried. The holidays were upon us, and it wasn't easy to get appointments in a timely fashion. The only reason I got going quickly--while my PSA was below 1.0, was that I had been doing my homework and knew that the clock was ticking.

I think that some urologists are a little too nonchalant about rising PSA after surgery. They need to read up more on the current research, and be quicker to refer their patients to radiation oncologists, since pre-radiation PSA is clearly a significant factor in success.

But I acknowledge that salvage is not for everyone whose PSA rises It's a second chance at a cure---the operative words being "chance" and "cure". It's only recently that salvage radiation has been show to apparently have a survival benefit.

Hope your recovery is still going well.[/quote]

Thank you Replicant. It's bad that you are having to deal with the unknown. The words "chance" & "cure" must be very tough for you at your age. There are so many unknown factors in this disease & I hope that your Doctors are able to help you redeuce these factors & get you cured. As for me, I'm writing you back at 5:45 am because I couldn't make it through the first post cahteter night with 1 pad. I just finished cleaning up the mess! Did you have to use more than a pad at night for a while & what did you use?
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

Replicant · Moderator Joined: 01 Nov 2006 Posts: 860

After a few days of pads not being in the right place at the right time, I bought some Depends and wore them especially at night. You know, the diapers. I figured if it's good enough for astronauts...

My main problem at night wasn't so much out-and-out urination, but leaking whenever I would change positions, like going from lying to sitting.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

cantexplain · Posted: Fri Nov 06, 2009 4:49 pm Post subject: Continence and Pads

I just had the catheter removed at noon and peed all over the floor. The surgeon's assistant who normally does the removal had her hands full in an other room, so the surgeon decided he'd do it himself. I'm thinking he's forgotten the Boy Scout motto: "Be Prepared" The catheter came out and I dropped a couple of ounces onto the linoleum between my feet. Not my fault!! Ha.
Anyhow, I took Replicant's advice in advance and bought the real deal, full on Depends and am so glad I did. I did a bit of banking on the way home, and stopped briefly at a cycle shop and by the time I arrived home, that Depends had given it's life for the cause. Another fresh one in place, and a dry afternoon to look forward to.
I also received the patholgy report, which the surgeon says is "great" and I have no reason to contest his interpretation of the report. Of course, continence and ED are the next issues, but apparently, I'm in the "99% Cured" club as far as PCa goes.

Chris.

PSA at surgery: 5.1
Staging after surgery: T2C
Gleason after: (3+4) (was 3+3 prior)
Tumors on both sides of the prostate, but negative margins all around, and no visible extrusion into the lymph nodes/seminal vesicles.

Travelingman · Posted: Sat Nov 07, 2009 7:36 am Post subject: Re: Continence and Pads

[quote="cantexplain"]I just had the catheter removed at noon and peed all over the floor. The surgeon's assistant who normally does the removal had her hands full in an other room, so the surgeon decided he'd do it himself. I'm thinking he's forgotten the Boy Scout motto: "Be Prepared" The catheter came out and I dropped a couple of ounces onto the linoleum between my feet. Not my fault!! Ha.
Anyhow, I took Replicant's advice in advance and bought the real deal, full on Depends and am so glad I did. I did a bit of banking on the way home, and stopped briefly at a cycle shop and by the time I arrived home, that Depends had given it's life for the cause. Another fresh one in place, and a dry afternoon to look forward to.
I also received the patholgy report, which the surgeon says is "great" and I have no reason to contest his interpretation of the report. Of course, continence and ED are the next issues, but apparently, I'm in the "99% Cured" club as far as PCa goes.

Chris.

PSA at surgery: 5.1
Staging after surgery: T2C
Gleason after: (3+4) (was 3+3 prior)
Tumors on both sides of the prostate, but negative margins all around, and no visible extrusion into the lymph nodes/seminal vesicles.[/quote]

Chris, I'm glad you're doing well. I got a similar report on my pathology. The ability to get a report with the extent of the cancer was one of the main reasons I chose surgery over radiation. I was convinced I did the right thing when I went from a biopsy showing 5% cancer in only one core (after 4 negative biopsies) & a 3+3=6 Gleason to a final pathology report showing 30% of my prostate having cancer with a 3+4=7 Gleason. If I had chosen radiation I might have always wonderd if I even needed treatment. Keep us informed as to your recovery. How long was the catheter in place? It is really good to be free of the ball & chain!

Ray
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

Travelingman

I am giving you folks a 3 week update. My surgery was 3 weeks ago today. It is interesting how each case is so different. I am still going through 8 to 10 pads a day. However, the following is very interesting & I hope will encourage others. Friday afternoon, 18 days post surgery, my wife & I were cuddling on the bed & it got pretty romantic. ( I will spare you the graphic details). At any rate, I felt something going on below & pulled my pad back to see that I had a pretty decent erection. After supper, I took 50 mgs of Viagra, (my first dose ever of this drug) & about 45 minutes later we went to the bedroom. I got another erection & was able to masturbate to a climax thanks to my wife's very romantic help. I am recounting this story to show that there is hope out there for all of us. My surgeon had told me he was able to spare both of my nerve bundles. Right now he is a real hero as far as I am concerned. We will try again next Friday night. Now on to the incontinence, What I am trying to understand is how the Kegels will help me. Here's why, if I tighten those muscles to prepare myself for some stressful thing such as bending in a certain way, they will only hold the urine back until I have to loosen the muscles again. Are these muscles supposeded to stay permanently contracted & if so how? My Dr. says it is very early & not to get discouraged. Did any of you guys suddenly go from using so many pads to a situation where you have major control? I'll give another example. When I go to bed at night I will stay relatively dry till I get up about 3 hours later. If I do not clamp my penis shut as I get up, the urine will shoot out. When I let go at the toilet, the urine shoots out. How do I get contol of this? I am doing Kegels but still don't know if I have the right muscles.
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

JustJB · Posted: Mon Nov 16, 2009 5:55 pm Post subject: Good stuff

Travelingman, thanks for the update. That is superbly good news on the ED front. Since you've updated, I'll throw my 11 day update in.
As you know, my path through surgery and recovery is a bit different due to two surgical mistakes. I spent 5 nights in the hospital recovering from the prostate surgery, umbilical hernia repair and the two mistakes. Total surgery time was around 8 hours, but it was all completed robotically.
Return of strength has been slow. I found the catheter to be uncomfortable and therefore wasn't moving around much. Last night I was very uncomfortable and managed a few hours of sleep till around 5:45 am. I was leaking around the catheter too. When I woke up I realized the catheter was not very full, I woke my wife and we went off to the emergency room. Of course, after 11 days, I had to go to the ER to get my catheter flushed a mere 3 hours before my appointment to have the silly thing removed! Oh well. The catheter was removed later at the surgeon's office with no issues. I received my pathology as well:
Gleason 'upgraded' to 3 + 4. Clear margins, no involvement of the nodes or nerves, one structure which was contained in the gland was labeled suspicious but there was no indication of spread,
One of my problems was a 'stricture' in the urethra which apparently resulted from some sort of pre-existing, possibly quite old, injury. The urethra still has the stricture so I will probably not end up with the lovely free flow of which I've been dreaming... It is even possible that I will need to have a 'bypass' of the stricture at some future time. The positive part of this is that I don't seem to have the lack of control that others do. Not for a real good reason, but I always look for the positive things in life!
Sorry for the long update but lots has going on!
_________________
Age 52
RRP 11-5-09
Post Surgical Gleason 3+4 = 7
Stage T1C
Pre-surgical PSA: 5.3
Post-surgical PSA: Undetectable at 13 weeks

PositiveGuy

My seven week update is a little different than the previous two. I am down to one pad per day and the leakage only appears at the end of the day when I think the muscles are fatigued. I am still following the Landry Protocol of exercises and in talks with him last week, I am considered continent in his opinion. I still think that there is room for improvement and I am continuing the exercises for another month. There is absolutely no progress on the ED front.

Keep well,
Regards,
Bill
_________________
Age 64. Diag. 01/09 PSA 5.6, Gleason 3+3=6, T1c TRUS biopsies of prostate left adenocarcinoma of prostate involving part of 1/4 biopsy fragments, less than 10% of the surface area involved, CT scan clear. RALP - 09/29/09, back home 10/02/09. Pathology - 10/14/09 Gleason Score 3+3 = 6 No positive margins. No Seminal Vesicle, Perineural, Lymphovascular or Lymph node involvement, and bladder neck cancer free.
10/16/09 - 3-4 pads a day, 10/31 2/day, 11/09 one pad/day
ED 10/16/09 - Zip, nada

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